Li Guodong, Xu Yongqing, He Xiaoqing, Luo Haotian, Dong Kaixuan, Wang Teng
Department of Orthopedics, Kunming General Hospital of Chengdu Military Region, Kunming Yunnan, 650032, P.R.China.
Department of Orthopedics, Kunming General Hospital of Chengdu Military Region, Kunming Yunnan, 650032,
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2017 May 15;31(5):564-569. doi: 10.7507/1002-1892.201612088.
To investigate the effectiveness of the digital technology in repairing tiny hand wounds with superficial lateral sural artery perforator flap.
Between August 2013 and October 2016, 10 cases of tiny hand wounds were treated with the superficial lateral sural artery perforator flap. There were 6 males and 4 females, aged 19 to 47 years (mean, 31.2 years). The causes included crushing injury by machine in 6 cases, traffic accident injury in 3 cases, and electric burning injury in 1 case. The location of the soft tissue defect was the first web in 2 cases, the thumb pulp in 3 cases, the index finger pulp in 1 case, the dorsal palms in 3 cases, and the dorsum of finger in 1 case. The time from injury to hospitalization was 4 hours to 10 days (mean, 3.5 days). The size of wound was from 4 cm×3 cm to 8 cm×7 cm. All defects were associated with exposure of tendon and bone. CT angiography (CTA) from aortaventralis to bilateral anterior and posterior tibial arteries was performed before operation, and the appropriate donor site as well as perforator was selected. Then the CTA data were imported into the Mimics15.0 software to reconstruct the three dimensional structure of the perforator artery, bone, and skin; according to flap size, the flap design and harvesting process were simulated. The flap was obtained on the basis of preoperative design during operation. The size of flaps varied from 5 cm×4 cm to 10 cm×8 cm. The donor site was sutured directly in 9 cases and repaired with skin grafting in 1 case.
Superficial medial sural artery peforator was cut in 3 patients whose superficial lateral sural artery was too narrow, and the flaps were obtained to repair defects smoothly in the others. Venous crisis occurred in 1 flap, which survived after exploration of the vessel, thrombus extraction, and thrombolysis; the other flaps survived successfully. All wounds and incisions healed by first intention. All cases were followed up 3-18 months (mean, 10 months). The flaps had good shape. At last follow-up, the results were excellent in 6 cases, good in 3 cases, and fair in 1 case according to total active motion (TAM).
The preoperative individualized design of the superficial lateral artery perforator flap can realize through CTA digital technology and Mimics15.0 software; it can reduce the operation risk and is one of better ways to repair the tiny hand wounds.
探讨数字技术在应用腓肠外侧动脉穿支皮瓣修复手部微小创面中的有效性。
2013年8月至2016年10月，应用腓肠外侧动脉穿支皮瓣治疗手部微小创面10例。男6例，女4例，年龄19～47岁，平均31.2岁。致伤原因：机器碾压伤6例，交通事故伤3例，电烧伤1例。软组织缺损部位：虎口2例，拇指指腹3例，示指指腹1例，手掌背侧3例，手指背侧1例。伤后至入院时间4小时至10天，平均3.5天。创面大小4 cm×3 cm～8 cm×7 cm。均伴有肌腱、骨质外露。术前行动脉CT血管造影（CTA），范围自腹主动脉至双侧胫前、胫后动脉，选择合适的供区及穿支。将CTA数据导入Mimics15.0软件，重建穿支动脉、骨骼及皮肤的三维结构；根据皮瓣大小模拟皮瓣设计及切取过程。术中按术前设计切取皮瓣。皮瓣大小5 cm×4 cm～10 cm×8 cm。供区9例直接缝合，1例植皮修复。
3例因腓肠外侧动脉过细切断腓肠内侧动脉穿支，其余顺利切取皮瓣修复缺损。1例皮瓣发生静脉危象，经血管探查、取栓、溶栓后成活；其余皮瓣均成活。所有创面及切口均一期愈合。所有病例随访3～18个月，平均10个月。皮瓣外形良好。末次随访时，按总主动活动度（TAM）评定：优6例，良3例，可1例。
通过CTA数字技术及Mimics15.0软件可实现腓肠外侧动脉穿支皮瓣术前个体化设计；能降低手术风险，是修复手部微小创面较好的方法之一。
